H&N: Pharyngo- oesophagoscopy

Pharyngoscopy and Oesophagoscopy

Indications

Examination, with or without biopsy, of the pharynx and oesophagus. This technique is used to investigate and stage tumours of the upper aerodigestive tract, in combination with imaging. It is used in the investigation of an unknown primary, where a patient presents with a metastatic cervical lymph node. This is performed as part of a “panendoscopy”, which also includes examination of the larynx, postnasal space and/or tonsillectomy (consent the patient specifically for this).

Removal of foreign bodies.

Procedure

The patient is positioned supine. The positioning of the head and neck vary, but a degree of neck extension is required. A mouth guard or wet swab is used to protect the upper teeth. A pharyngoscope is advanced into the pharynx and used to examine each sub-site systematically. A Hopkins rod (which may be angled) can be used to enhance the view, and pictures may be taken. Biopsies (usually multiple) are taken of any abnormal areas. The oropharynx and neck are usually palpated under anaesthesia.

A rigid oesophagoscope is then passed gently into the cervical oesophagus, which is examined to the full length of the scope.

Length of procedure

A straightforward diagnostic procedure may take only 15 minutes.

Complications

Pain Patients are likely to have a slightly sore throat.

Bleeding Usually very minor, unless the pharynx is injured unintentionally.

Dental/lip/jaw trauma Ask patients about their dentition and document carefully.

Perforation/mediastinitis Rare but serious complication. Mainly a risk of oesophagoscopy. The patient should be warned specifically about this possibility and its consequences. They would need to stay in hospital for at least two weeks, fed via a nasogastric tube. Occasionally an open surgical repair is required (external neck wound). Mediastinitis is rare but has a high mortality.

Need for further treatment Dependent on histology.

Post-operative management

A patient will usually go home the same day and be followed up in clinic in approximately two weeks for histology results.

Be wary of signs of perforation. The patient should be monitored closely for a number of hours for: chest pain (may radiate to the back), tachypnoea, tachycardia, low-grade fever, dysphagia or surgical emphysema. These symptoms and signs should prompt urgent senior review.